Fact Check: migration and NHS staff

Briefing

Author

What proportion of the NHS's staff come from the European Union?

The nationality of NHS staff

55,000 out of the 1.2 million staff in the English NHS are citizens of other EU countries, according to the English health service's Electronic Staff Record. This includes doctors; nurses; other professionals like paramedics and pharmacists; support workers providing care; and administrative staff.

Assuming that the staff who were not asked or did not fill out this field had a similar mix of nationalities to those who did, this implies that five per cent of NHS trust staff hold EU nationality – compared to around 4.9 per cent of the population of England.

Ten per cent of doctors and four per cent of nurses are from the EU

We can get a fuller picture in the case of doctors and nurses by looking at the records their regulators keep of where each person registered in the UK carried out their original training. This should include EU migrants who have been here several years and obtained British citizenship, and allows us to look across all four home nations.

Doctors from the European Economic Area (the EU plus Iceland, Norway and Liechtenstein) and Switzerland have long made up a significant proportion of the UK’s medical workforce. Academics have singled out the UK as one of the developed countries that relies most on importing doctors trained abroad.

Most come from outside Europe, but more than one in ten of those registered to practice as a doctor (a group which may include some people who have retired or are in other lines of work) is an EU immigrant.

The proportion of registered nurses and midwives from the EU is lower, at slightly above four per cent. However, this represents a sharp expansion from even a few years ago. EU immigrant nursing numbers have risen at a time when the numbers of British-trained nurses has actually fallen.

Although data is far from complete, there are a few points which seem clear about the number of EU migrants working in the NHS.

Firstly, EU migrants make up a significant proportion of NHS staff – over 10 per cent in the case of doctors – but not as large a proportion as non-EU migrants.

Secondly, EU migrants are slightly more likely than the population overall to be NHS staff generally. They are disproportionately likely to be doctors – but not to be nurses.

Lastly, in nursing and midwifery, EU immigrants make up a small proportion, but their numbers have been increasing at a historically rapid rate in recent years as the number of nurses trained in Britain has dropped. Without this, overall nursing numbers would have fallen rather than remaining more or less steady.

What could be the impact of Brexit, and the changes accompanying it, on the future health service workforce?

They have suggested this could be caused directly, through new restrictions preventing EU-born NHS staff from working in Britain, or indirectly, because EU-born staff will leave the UK pre-emptively due to the 'uncertainty' created when migration restriction becomes possible.

How can we inform our estimate of the effect a post-Brexit immigration tightening would have on the NHS?

There is no exact precedent to look at in order to judge these claims, as they depend on hypothetical decisions and perceptions after a British exit.

There are good reasons to see this as a relevant example. If EU immigrants were simply treated in the same way as non-EU immigrants after exit from the union, these would be the exact rules applied. Even if some other package of restrictions was used, these rules reflect themes which have been cited by many proponents of leaving the European Union: reductions or caps in numbers, an emphasis on only allowing immigrants with especially economically valuable skills, and the use of a points-based system.

Did the changes around 2010 have a real impact on NHS recruitment over the following years?

Over the years following 2010, it does appear that the package of restrictions had a subtle but clear impact on NHS recruitment.

Did staff leave pre-emptively due to concern at the direction of policy?

There was no evidence of a collapse in the numbers of non-EU nurses to suggest a general flight motivated by uncertainty. These remained steady at around 37,000.

The rate of non-EU doctors registering in the UK slowed slightly after 2010, as shown below. However, there is again no sign of pre-emptive flight. The total number of doctors trained outside the EU has still been rising by several hundred each year.

This briefing was written by Mark Dayan of the Nuffield Trust in collaboration with Full Fact and was also published on the Full Fact website.